Forms

New Patient Forms

• New Patient Packet

Yearly Updates

We require a yearly update to the following forms:

• Demographic Information
• Acknowledgement of Financial Policy

Consent Forms

It is generally our policy that all patients under 18 years of age must be accompanied to all appointments by a parent or legal guardian. Learn more about our policy.

• Consent to Treat Today - Use for a one-time case where you will not be able to accompany your child to the office. A signed, faxed "Consent to Treat Today" form, sent by the parent with a valid phone number where the parent can be reached during the appointment. The parent MUST be available.
• Power of Attorney - If the parent will not be available (out of the country, etc.) during the appointment a "Power of Attorney" form must be filled out and brought by the caretaker to any appointments while the parents are unavailable.

Administrative Forms

• Medical Records Release - Authorization for Release of Medical Records.

Behavior and Development Forms

• Vanderbilt Parent & Teacher Rating Forms